Brian J Potter1, Giuseppe Andò2, Giovanni Cimmino3, Ricardo Ladeiras-Lopes4, Zied Frikah1, Xin Yue Chen1, Vittorio Virga2, Joao Goncalves-Almeida4, A John Camm5, Keith A A Fox6. 1. CHUM Research Center and Cardiovascular Center, Montréal, Canada. 2. Department of Clinical and Experimental Medicine, Section of Cardiology, University Hospital of Messina, Messina, Italy. 3. Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy. 4. Department of Cardiology, Gaia Hospital Centre, Vila Nova de Gaia, Portugal. 5. St. George's University of London, London, United Kingdom. 6. Centre for Cardiovascular Science and Royal Infirmary, Edinburgh, United Kingdom.
Abstract
BACKGROUND: Antithrombotic management of patients with atrial fibrillation (AF) requiring percutaneous coronary intervention (PCI) is highly variable; limited evidence-based guidelines exist to influence practice. HYPOTHESIS: Patient characteristics and availability of novel drugs may have contributed to practice variability. METHODS: We undertook an international multicenter retrospective registry of AF patients treated with PCI. The primary measures of interest were antiplatelet and OAC prescriptions at discharge. We compared temporal trends between Prior (2010-2012) and Recent (2013-2015) cohorts and investigated variables associated with OAC prescription. RESULTS: We identified 488 cases (140 Prior, 348 Recent). Median CHADS2 and HAS-BLED scores were 2 (IQR, 1-3) and 2 (IQR, 2-3). Clinical characteristics were similar between cohorts, with high (85%) prevalence of ACS. More patients in the Recent cohort, compared with Prior, received OAC (56.9% vs 44.3%; P = 0.01) and NOAC (27.3% vs 3.6%; P < 0.01) at baseline. Triple therapy at discharge was not different between the cohorts. Clinical presentation with ACS and consequent use of potent P2Y12 inhibitors were associated with reduced odds of OAC prescription at discharge (OR: 0.57, P = 0.045 and OR: 0.38, P = 0.023, respectively). CONCLUSIONS: Despite little change over time in clinical characteristics of AF patients undergoing PCI, significantly more patients received OAC at presentation. However, triple therapy was not more frequent in the Recent cohort, and ACS presentation was associated with lack of OAC at discharge. We underscore the need for trial evidence and use of updated guidelines to assist clinicians in balancing ischemic and bleeding risks.
BACKGROUND: Antithrombotic management of patients with atrial fibrillation (AF) requiring percutaneous coronary intervention (PCI) is highly variable; limited evidence-based guidelines exist to influence practice. HYPOTHESIS: Patient characteristics and availability of novel drugs may have contributed to practice variability. METHODS: We undertook an international multicenter retrospective registry of AFpatients treated with PCI. The primary measures of interest were antiplatelet and OAC prescriptions at discharge. We compared temporal trends between Prior (2010-2012) and Recent (2013-2015) cohorts and investigated variables associated with OAC prescription. RESULTS: We identified 488 cases (140 Prior, 348 Recent). Median CHADS2 and HAS-BLED scores were 2 (IQR, 1-3) and 2 (IQR, 2-3). Clinical characteristics were similar between cohorts, with high (85%) prevalence of ACS. More patients in the Recent cohort, compared with Prior, received OAC (56.9% vs 44.3%; P = 0.01) and NOAC (27.3% vs 3.6%; P < 0.01) at baseline. Triple therapy at discharge was not different between the cohorts. Clinical presentation with ACS and consequent use of potent P2Y12 inhibitors were associated with reduced odds of OAC prescription at discharge (OR: 0.57, P = 0.045 and OR: 0.38, P = 0.023, respectively). CONCLUSIONS: Despite little change over time in clinical characteristics of AFpatients undergoing PCI, significantly more patients received OAC at presentation. However, triple therapy was not more frequent in the Recent cohort, and ACS presentation was associated with lack of OAC at discharge. We underscore the need for trial evidence and use of updated guidelines to assist clinicians in balancing ischemic and bleeding risks.
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